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Response to intervention with antihistamines and the safety of further acetylcysteine administration are discussed

In: Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors

Additionally, cholesterol overload disrupts ER calcium homeostasis, leading to excessive cytosolic calcium release, which exacerbates mitochondrial dysfunction by inducing mitochondrial permeability transition pore (mPTP) opening, further increasing ROS production and triggering hepatocyte apoptosis [120]

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This explains why we see both symptoms of hyper- and hypothyroidism in people with Hashimotos, in addition to a few symptoms that are typical of Hashimotos especially those related to gastrointestinal distress, like irritable bowel syndrome (IBS), acid reflux (GERD), diarrhea, constipation, and bloating